Elbow pain: epicondylitis, causes and treatment
Elbow pain mainly affects people who repeat the same movement with the wrist and hand: in tennis and padel, golf, the gym, at the computer or in manual work. In most cases the problem lies in the tendons that attach to the elbow, and the most effective treatment is progressive loading of those tendons, not rest.
The most common causes
Lateral epicondylitis ("tennis elbow"): pain on the outside of the elbow when gripping objects, turning a key or lifting a cup. It is a tendinopathy of the muscles that extend the wrist.
Medial epicondylitis ("golfer's elbow"): pain on the inside when gripping hard or bending the wrist.
Ulnar nerve compression: tingling in the ring and little fingers, especially with the elbow bent for long periods. Find out more about neuropathic pain.
Olecranon bursitis: soft swelling at the tip of the elbow, often from leaning on a desk for long periods.
Traumatic injuries: after a fall onto the hand or an elbow sprain.
When to seek urgent help
Deformity or inability to move the elbow after a fall.
A warm, red, swollen elbow, especially with a fever.
Loss of strength in the hand or numbness that doesn't go away.
How we diagnose it
At a pain medicine consultation, the clinical examination locates the tendon or nerve involved. Ultrasound shows the state of the tendon (thickness, partial tears, blood flow) and allows progress to be monitored. It is also important to understand the movement that overloads the elbow: the racket grip, gym technique or workstation.
Treatment
Physiotherapy with progressive loading: strength exercises for the forearm muscles, increased week by week, and technique correction. This is the foundation of treatment for epicondylitis.
Adjust the load, don't stop: temporarily reduce the movements that hurt most, while staying as active as possible.
Platelet-rich plasma (PRP) under ultrasound guidance: an option for tendinopathies that don't improve with exercise.
Corticosteroid injections: relieve pain in the short term but can delay tendon recovery, so they are used with caution.
How the exercise plan usually progresses
Relief phase: isometric exercises (contracting without moving the wrist) several times a day, which usually reduce pain.
Strength phase: weighted exercises for the forearm muscles, including the slow lowering phase of the movement, increasing the load week by week.
Movement phase: grip, rotation and speed exercises that resemble your sport or work.
Full return: back to normal playing or working volume, keeping up two strength sessions a week.
How to prevent it
In tennis and padel: check the racket grip size, string tension and backhand technique.
In the gym: increase loads gradually and vary your grips.
At work: alternate tasks, use a mouse that keeps the wrist neutral and take short breaks.
Keep the forearm and shoulder muscles strong, especially if you play several times a week.
Frequently asked questions about elbow pain
Should I wear a brace for epicondylitis?
It can relieve pain during exertion, but it doesn't treat the cause. It should be used as support while following the exercise plan.
How long does tennis elbow take to go away?
With a well-targeted exercise plan, most people improve over a few weeks to a few months. Without treatment, the pain can last a long time.
Can I keep playing tennis or padel?
Often yes, with adjustments to intensity, equipment and technique. Your physiotherapist will tell you what to keep and what to adapt at each stage.
Do I need surgery?
Rarely. Surgery is reserved for cases that don't respond to several months of well-delivered treatment.
Dr. Miguel Reis e Silva
Doctor at Sport Lisboa e Benfica
Medical Director and Founder of Clínica Myalgia
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